Can you take Lasix (furosemide) and Jardiance (empagliflozin) at the same time?

Combining Lasix (Furosemide) and Jardiance (Empagliflozin)

Yes, Lasix (furosemide) and Jardiance (empagliflozin) can be taken together, but this combination requires careful monitoring due to their overlapping diuretic effects and potential for electrolyte imbalances.

Mechanism of Action and Diuretic Effects

• Lasix (furosemide) is a loop diuretic that works by inhibiting sodium and chloride reabsorption in the ascending loop of Henle, leading to increased urine output 1
• Jardiance (empagliflozin) is an SGLT2 inhibitor that reduces renal glucose reabsorption, resulting in increased urinary glucose excretion and a mild diuretic effect 2
• The combination of these medications produces an additive diuretic effect, which can be beneficial in patients with volume overload but requires careful monitoring 2

Evidence Supporting Combination Use

• The EMPEROR-Preserved trial demonstrated that empagliflozin was effective and safe when used with background diuretic therapy in heart failure patients 2
• Empagliflozin was associated with decreased need for conventional diuretic dosing, suggesting a complementary effect when used together 2
• The combination may be particularly beneficial in patients with heart failure, as empagliflozin has been shown to reduce the risk of hospitalization for heart failure 3

Potential Risks and Monitoring Requirements

• The combination increases the risk of volume depletion (34% higher risk when empagliflozin is added to diuretic therapy) 2
• Enhanced electrolyte depletion is a significant concern, particularly hypokalemia and hypomagnesemia 1, 4
• The risk of electrolyte abnormalities is markedly increased when multiple diuretics are used together 1, 4
• Hypotension may occur due to the additive diuretic effects of both medications 1, 2
• Renal function should be monitored as both medications can affect kidney function 1, 2

Recommendations for Combined Use

• Start with appropriate doses of each medication and adjust based on clinical response 1
• Monitor electrolytes (especially potassium and magnesium) regularly, particularly after initiation or dose changes 4
• Consider adding an ACE inhibitor or potassium-sparing diuretic (like spironolactone) to help prevent electrolyte depletion 1, 4
• Monitor blood pressure closely, especially during the initial period of combined use 1, 2
• Assess renal function periodically, as declining function may require dose adjustments 1, 2
• Watch for signs of excessive diuresis: dizziness, lightheadedness, extreme thirst, or decreased urine output 1, 2

Special Considerations

• In patients with heart failure, the combination may be particularly beneficial as empagliflozin has been shown to reduce heart failure hospitalizations and mortality 3
• Patients with diabetes should monitor blood glucose levels, as empagliflozin lowers blood glucose 5
• Be aware of the rare but serious risk of euglycemic diabetic ketoacidosis with empagliflozin, especially during acute illness 6
• Elderly patients may be more susceptible to volume depletion and electrolyte abnormalities with this combination 4

Practical Management Tips

• Daily weight monitoring can help guide diuretic dosing and detect fluid retention early 1
• Instruct patients to report symptoms of electrolyte imbalances (muscle cramps, weakness, palpitations) 4
• Consider temporary reduction of furosemide dose when initiating empagliflozin to avoid excessive diuresis 2
• Ensure adequate fluid intake to prevent dehydration, but avoid excessive sodium consumption 1